Asplenia physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anum Dilip, M.B.B.S[2]
Overview
Physical Examination
Physical examination of patients with asplenia is:
- During the physical examination, the spleen is usually not palpable except in individuals with thin abdominal musculature, hence lack of a palpable spleen does not confirm asplenia.[1]
- Patients with sickle cell disease, especially children in their earlier years, may have enlarged nonfunctional spleen.[2]
- In the case of visceral heterotaxy, a right-sided liver may be mistaken for splenic enlargement.
- Other physical findings depend on the associated anomalies.
- In isolated congenital asplenia, for diagnosis, there are no other physical clues and overwhelming infection may be the first sign of the disease.[3]
Vital Signs
Skin
- Cyanosis may be present in congenital asplenia with visceral heterotaxy with bilateral right-sidedness.[2]
Neck
- Neck examination of patients with asplenia is usually normal.
Lungs
- Respiratory distress may be present in congenital asplenia with visceral heterotaxy with bilateral right-sidedness. [2]
Heart
- Cardiovascular examination of patients with [disease name] is usually normal.
OR
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with [disease name] is usually normal.
OR
- Abdominal distension
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
- Back examination of patients with [disease name] is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with [disease name] is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
References
- ↑ Erdem SB, Genel F, Erdur B, Ozbek E, Gulez N, Mese T (2015). "Asplenia in children with congenital heart disease as a cause of poor outcome". Cent Eur J Immunol. 40 (2): 266–9. doi:10.5114/ceji.2015.52841. PMC 4637402. PMID 26557043.
- ↑ 2.0 2.1 2.2 Thiruppathy K, Privitera A, Jain K, Gupta S (2008). "Congenital asplenia and group B streptococcus sepsis in the adult: case report and review of the literature". FEMS Immunol Med Microbiol. 53 (3): 437–9. doi:10.1111/j.1574-695X.2008.00422.x. PMID 18564289.
- ↑ Iijima S (2017). "Sporadic isolated congenital asplenia with fulminant pneumococcal meningitis: a case report and updated literature review". BMC Infect Dis. 17 (1): 777. doi:10.1186/s12879-017-2896-5. PMC 5735542. PMID 29254492.